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Professional QualitiesCurriculum

curr culumtra ning


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Physician and PaediatricianTraining Program

Professional Qualities Curriculum

To be used in conjunction with:

Basic Training Curricula

Adult Internal Medicine

Paediatrics & Child Health

Advanced (Subspecialty) Training Curricula


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Acknowledgements

A number of Fellows, trainees and College staff have contributed extensively of their time and professional expertise inthe design and development of this curriculum document.

The College would specifically like to thank those Fellows and trainees who have generously contributed to thedevelopment of these curriculum documents, through critical comment drawn from their knowledge and experienceand the donation of their time and professional expertise.

The following Fellows, in particular, deserve specific mention for their contribution:

y Kevin Forsyth

y Stephen Judd

y Mary-Ann Ryall

The development process was managed by the Colleges Curriculum Development Unit, who designed the document,drafted content material, organised and facilitated writing workshops, and developed resource materials.

COPYRIGHT

1st edition 2007 (revised 2010, 2013).

Please note: No Domains, Themes or Learning Objectives have been updated for this edition; design changes ONLY.

Copyright 2013. The Royal Australasian College of Physicians (RACP). All rights reserved. Published20 December 2013.

This work is copyright. Apart from any fair use, for the purposes of study or research, it may not be reproduced in wholeor in part, by any means, electronic or mechanical, without written permission from The Royal Australasian College ofPhysicians.


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AUSTRALIA

145 Macquarie Street

SYDNEY

NSW 2000

Australia

Tel: (+61) (2) 9256 5444

Fax: (+61) (2) 9252 3310

Email: [email protected]

Website: www.racp.edu.au

Contact Details

THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANS

NEW ZEALAND

5th Floor

99 The Terrace

WELLINGTON 6011

New Zealand

Tel: (+64) (4) 472 6713

Fax: (+64) (4) 472 6718

Email: [email protected]

Website: www.racp.edu.au


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Contents

RACP Fellowship Training Pathways and the Continuum of Learning 6

Introduction 7

Overview of the Professional Qualities Curriculum 7

Expected Outcomes at the Completion of Training 8

Common Attitudes and Behaviours 8

Assessment 10

Curriculum Domains, Themes and Learning Objectives 11

Learning Objective Tables 19

References 51


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RACP FELLOWSHIP TRAINING PATHWAYS AND THE CONTINUUM OF LEARNING

P Trainees must complete Basic Training in Paediatrics & Child Health to enter this program.A Trainees must complete Basic Training in Adult Medicine to enter this program.1 Trainees who have entered Advanced Training in Palliative Medicine via a RACP Basic Training Program will be awarded FRACP upon

completion and may subsequently be awarded FAChPM. Trainees who have NOT entered Advanced Training in Palliative Medicine via a RACPBasic Training Program will only be awarded FAChPM upon completion.

2 The Child & Adolescent Psychiatry Joint Training Program with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) iscurrently under review by the RACP and RANZCP and closed to new entrants at present.

3 Alternative entry requirements exist for these training programs; please see the corresponding PREP Program Requirements Handbook for

further information.NB1: This diagram only depicts training programs that lead to Fellowship. Please see the RACP website for additional RACP training programs.NB2: For further information on any of the above listed training programs, please see the corresponding PREP Program Requirements Handbook.

Foundationmedicalstudies andworkplaceexperience

RACP PREP Training Professionalpractice

QualificationBasic TrainingPrograms

Advanced Training Programs

Division Training Programs

Chapter Training Programs

Joint Training Programs 2

Faculty Training Programs

Basic Trainingin AdultMedicine

Basic Trainingin Paediatrics

& ChildHealth

InitialMedical

Qualification

One or moreinitial post-

graduateyears in theworkplace

Cardiology

Clinical Genetics

Clinical Haematology

Clinical Immunology & Allergy

Clinical Pharmacology

Community Child Health P

Dermatology (NZ only)

Endocrinology

Gastroenterology

General & Acute Care Medicine A

General Paediatrics P

Geriatric Medicine A

Infectious Diseases

Medical Oncology

Neonatal/Perinatal Medicine P

Nephrology Neurology

Nuclear Medicine

Palliative Medicine 1

Respiratory Medicine

Rheumatology

Sleep Medicine

RACP & The Australasian Faculty of

Rehabilitation Medicine (AFRM)

Paediatric Rehabilitation MedicineP

RACP & The Royal College of

Pathologists of Australasia (RCPA)

Endocrinology & ChemicalPathology

Haematology

Immunology & Allergy

Infectious Diseases & Microbiology

RACP & The Australasian College

for Emergency Medicine (ACEM)

Paediatric Emergency Medicine3

Addiction Medicine 3

Palliative Medicine1,3

Sexual Health Medicine 3

Rehabilitation Medicine 3

Occupational & Environmental Medicine 3

Public Health Medicine 3

FRACP

FRACP &FAFRM

FRACP &FRCPA

FAChAM

FAChPM

FAChSHM

FAFRM

FAFOEM

FAFPHM

ContinuingProfessionalDevelopment

FRACP &/ORFACEM


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INTRODUCTION

This Curriculum outlines the broad concepts, relatedlearning objectives and the associated theoreticalknowledge, clinical skills, attitudes and behavioursrequired and commonly utilised by all physicians andpaediatricians within Australia and New Zealand,

regardless of their area of specialty.This curriculum complements learning objectives,detailed in the Basic Training Curricula for Adult Medicineand Paediatrics & Child Health, and the various Advanced(Subspecialty) Training Curricula, and is pitched at thestandard consistent with that expected of a graduatetrainee, accepting full responsibility for the patientswelfare and clinical care.

It is expected that all teaching, learning and assessmentassociated with the Professional Qualities Curriculumwill be undertaken within the context of the physicianseveryday clinical practice and will accommodatediscipline-specific contexts and practices as required. As

such it will need to be implemented within the reality ofcurrent workplace and workforce issues and the needs ofhealth service provision.

There may be learning objectives that overlap with orcould easily relate to other domains; however, to avoidrepetition, these have been assigned to only one area.In practice, however, it is anticipated that within theteaching/learning environment, the progression of eachobjective would be explored.

Note: The curricula should always be read in conjunctionwith the relevant College Program RequirementsHandbook, available on the College website.

OVERVIEW OF THE PROFESSIONAL QUALITIES CURRICULUM

The Professional Qualities Curriculum outlines the range of concepts and specific learningobjectives required by, and utilised by, all physicians, regardless of their specialty orarea of expertise. It spans both the Basic Training and Advanced Training Programs andis also utilised as a key component of the Continuing Professional Development (CPD)Program. Together with the various Basic Training and Advanced Training Curricula,the Professional Qualities Curriculum integrates and fully encompasses the diagnostic,clinical and educative-based aspects of the physicians/paediatricians daily practice.

All aspects of the Professional Qualities Curriculum will be taught, learnt and assessedwithin the context of everyday clinical practice and, where appropriate, will be givena subspecialty-specific focus.


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EXPECTED OUTCOMES AT THECOMPLETION OF TRAINING

Graduates from this training program will be equippedto function effectively within the current and emergingprofessional, medical and societal contexts. At thecompletion of their overall training program, it is expected

that a new Fellow will:

y have demonstrated their knowledge of, and ability tocompetently utilise the range of common or genericknowledge, skills, attitudes and behaviours requiredby all physicians/paediatricians, regardless of theirarea of specialty

y be able to communicate effectively and sensitivelywith patients and their families, colleagues and otherallied health professionals

y understand and acknowledge the importance of thevarious socio-economic factors that contribute toillness and vulnerability

y be aware of, and sensitive to, the special needs ofpatients from culturally and linguistically diversebackgrounds

y be able to work within, lead and fully utilisemultidisciplinary team-based approaches to theassessment, management and care of their patients

y recognise the need for, develop, and be able to applyappropriate patient advocacy skills

y have the skills required to process new knowledgeand the desire to promote and maintain excellencethrough actively supporting or participating in

research and an active program of continuingprofessional development

y be able to contribute to the education of patients,colleagues, Trainees, junior medical officers and otherhealth care workers.

COMMON ATTITUDES ANDBEHAVIOURS

The range of desirable personal and professionalbehavioural attitudes required of, and commonlyutilised by, all consultant physicians and paediatriciansin the course of their daily clinical practice and in their

relationship with others are listed below. These willfacilitate appropriate patient care and managementassociated with professional practice when workingwith patients, their families, professional colleagues,allied medical and administrative personnel. Dependingupon the clinical context, each of these may be utilisedindividually or, more commonly, in combination withothers.

PERSONAL ATTITUDES AND BEHAVIOURS

y fostering of a patient-centred approach to health care

y maintenance of a balanced and broad perspective on

health care deliveryy preparedness to learn and adopt new and validated

approaches to diagnosis and management, despitelogistical difficulties, and to change work practiceswhen appropriate

y willingness to reflect on, and learn from, mistakes

y preparedness to change management plans

y tolerance of uncertainty

y ability to cope with unexpected disappointments

y equanimity, resiliency and calmness in the face ofchallenging clinical demands

y desire to contribute to improvements in the healthsystem

y desire to foster clinical practice, research and teachingin general internal medicine

y preparedness to acknowledge doubt and uncertaintyin clinical practice.


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ATTITUDES AND BEHAVIOURS WITHPATIENTS AND FAMILIES

y use of a positive, compassionate, caring and empathicattitude towards patients and their family/carers

y involvement of patients as equals in identification oftreatment priorities and in the development of the

care plan

y ensuring patient confidentiality, particularly whereothers are involved in the development of a care plan

y imparting of bad news in a compassionate andpositive manner

y use of a clinical approach that models and reinforcespreventive and prophylactic approaches to healthcare

y encouragement of patient mastery, includingparticipation in self-awareness and rehabilitationprograms

y use of a non-judgemental approach to the assessmentof all determinants of illness

y willingness to accede to requests for a second opinion

y provision of constructive and evidence-basedadvice on complementary and alternativemanagement approaches, when patientswish this.

ATTITUDES AND BEHAVIOURS WITHCOLLEAGUES

y preparedness to collaborate with primary carers,other referrers and sub-specialists in the care ofpatients by providing consultative advice, sharing ofcare, or accepting ongoing care in the best interests

of the patienty willingness to work in a multidisciplinary team

y use of an independent, assertive, inquiring butnonetheless professionally courteous manner ininteractions with subspecialty colleagues

y willingness to share knowledge and skills withcolleagues

y fostering of a peer network, and collaborativerelationships in the health care system

y provision of reassurance and support to colleagues

y zero tolerance in the workplace of sexual harassment

and discrimination

y respect for and acknowledgement of professionalcontributions of all others in the workplaces,including office staff and employees.


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ASSESSMENT

Overview

Below is an overview of the assessment tools used during Basic Training. A variety

of tools will be used, with the emphasis on provision of constructive feedback toTrainees, to aid their learning. The assessment tools will require the Trainee to providegood patient care, and act as quality assurance towards this goal. Thus the better aperson performs on the job, the better they will perform within the formal assessmentprogram.

OUTLINE OF ASSESSMENT

A similar range of assessment will be employed for BasicTraining and Advanced Training. This section deals with

those tools that will be used during Basic Training.

Formative mini-Clinical Evaluation Exercise(mini-CEX)

Trainees will be required to complete a number offormative mini-CEX activities throughout Basic Training,covering history taking, clinical examination, and healthpromotion aspects of the curriculum. These will be carriedout in the trainees usual workplace.

Multi-Source Feedback (MSF)

Also known as 360 feedback, the MSF is designed to

assess areas of the Professional Qualities Curriculum,particularly around communication, management, and,to some degree, cultural competency.

APLS/ALS course

Is compulsory for all trainees, and should ideally becompleted during Basic Training.

Centralised Written Examination

A multiple-choice examination, blueprinted to thecurriculum.

Centralised Clinical Examination

Consists of two long cases and four short cases.

HOW THEY ARE TO BE USED

Progression to Advanced Training will depend oncompletion of the requirements for basic training as well

as:y A summative written examination

y Four summative short cases and two summative longcases, which make up the central clinical examination.

NOTE: Trainees should refer to the RACP Basic TrainingPortal (www.racp.edu.au/btp) for the most up-to-dateassessment requirements.


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CURRICULUM DOMAINS, THEMES AND LEARNING OBJECTIVES

Each of the curriculum documents has been developed using a common format,thereby ensuring a degree of consistency and approach across the spectrum of training.

Domains

The Domains are the broad fields which group common or related areas of learning.

Themes

The Themes identify and link more specific aspects of learning into logicalor related groups.

Learning Objectives

The Learning Objectives outline the specific requirements of learning. They providea focus for identifying and detailing the required knowledge, skills and attitudes.

They also provide a context for specifying assessment standards and criteria as well asproviding a context for identifying a range of teaching and learning strategies.

DOMAINS

DOMAIN 1: COMMUNICATION

Theme 1.1: Physicianpatient Communication

Theme 1.2: Communicating with a Patients Family and/or Carers

Theme 1.3: Communicating with Colleagues and Broader Health Care Team

Theme 1.4: Communicating with the Broader Community

DOMAIN 2: QUALITY AND SAFETY

Theme 2.1: Using Evidence and Information

Theme 2.2: Safe Practice

Theme 2.3: Identifying, Preventing and Managing Potential Harm

DOMAIN 3: TEACHING AND LEARNING (SCHOLAR)

Theme 3.1: Ongoing Learning

Theme 3.2: Research

Theme 3.3: Educator

DOMAIN 4: CULTURAL COMPETENCY

Theme 4.1: Cultural Competency


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DOMAINS (Cont.)

DOMAIN 5: ETHICS

Theme 5.1: Professional Ethics

Theme 5.2: Personal EthicsTheme 5.3: Ethics and Health Law

DOMAIN 6: CLINICAL DECISION MAKING

Theme 6.1: Clinical Decision Making

DOMAIN 7: LEADERSHIP AND MANAGEMENT

Theme 7.1: Self-Management

Theme 7.2: Leadership and Managing Others

DOMAIN 8: HEALTH ADVOCACY

Theme 8.1: Advocacy for the Patient

Theme 8.2: Individual AdvocacyTheme 8.3: Group Advocacy

DOMAIN 9: THE BROADER CONTEXT OF HEALTH

Theme 9.1: Burden of Disease

Theme 9.2: Determinants of Health

Theme 9.3: Prevention and Control

Theme 9.4: Priority Population Groups

Theme 9.5: Economics of Health

Domain 1: Communication

In order to provide high-quality care for patients, it is essential that physicians establish and foster effectiverelationships with patients and their families, other health care professionals and administrative personnel.

To achieve this they must develop and utilise the full range of communication-related skills that wil l enable themto effectively obtain and synthesise information from, and discuss relevant issues with, patients and their families,professional colleagues, administrative personnel and systems as appropriate. These communication skills willbe characterised by understanding, trust, respect, empathy and confidentiality. Effective communication skillswill also facilitate their ability to research, evaluate and disseminate information in the broader community.

We know that first encounters can have a profound effect on practice; therefore it is important to developeffective communication strategies early on in training.

THEME 1.1: PHYSICIANPATIENT COMMUNICATION

Learning Objectives

1.1.1 Apply communication skills to engage and reassure the patient in specific situations including: firstencounters, history taking, counselling and breaking bad news

1.1.2 Empower patients and be respectful of their rights in all aspects of communication


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Domain 1: Communication (Cont.)

THEME 1.2: COMMUNICATING WITH A PATIENTS FAMILY AND/OR CARERS

Learning Objectives

1.2.1 Apply communication skills in encounters with a patients family (including extended family) and/orcarers

THEME 1.3: COMMUNICATING WITH COLLEAGUES AND BROADER HEALTH CARE TEAM

Learning Objectives

1.3.1 Communicate effectively within multidisciplinary teams

1.3.2 Communicate effectively with referring doctors, and when referring a patient to another specialist

1.3.3 Apply communication skills to facilitate effective clinical handover and transfer of care

1.3.4 Communicate effectively with health administration

THEME 1.4: COMMUNICATING WITH THE BROADER COMMUNITY

Learning Objectives1.4.1 Communicate effectively with support organisations, administrative bodies, governments and others

in the wider community

1.4.2 Demonstrate the ability to apply specific medico-legal communication practices

Domain 2: Quality and Safety

Quality and safety guidelines are developed to ensure the safe and quality care of patients. The implementationof these standards is the responsibility of all health care workers. Physicians must consider quality and safetyin every aspect of their practice, from their interactions (communication) with patients, to managing andreporting risks and hazards.

THEME 2.1: USING EVIDENCE AND INFORMATION

Learning Objectives

2.1.1 Use evidence to inform quality improvement

THEME 2.2: SAFE PRACTICE

Learning Objectives

2.2.1 Optimise safe work practice, which minimises error

2.2.2 Facilitate safe prescribing and administration of medication and display an understanding of theassociated error types, causes and risks

2.2.3 Promote safe continuity of care for patients


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Domain 2: Quality and Safety (Cont.)

THEME 2.3: IDENTIFYING, PREVENTING AND MANAGING POTENTIAL HARM

Learning Objectives

2.3.1 Recognise, report on and manage adverse events and error

2.3.2 Identify, establish, implement and/or comply with relevant risk-management/minimisation procedures

2.3.3 Understand the process of managing patient complaints and how to utilise patient complaints toenhance medical care

Domain 3: Teaching and Learning (Scholar)

Physicians should actively contribute to the further research, development, appraisal, understanding anddissemination of health care knowledge among their professional colleagues, students and patients and withinthe broader general community.

As with any profession, physicians need to model and engage in a process of continuing personal, professionaland educational development in order to maintain, further develop and extend their professional knowledge,clinical skills and technical expertise. This is especially important within the current context of an ever-increasing, rapid and exponential growth in knowledge and its related applications.

THEME 3.1: ONGOING LEARNING

Learning Objective

3.1.1 Participate in effective continuing professional and educational development

THEME 3.2: RESEARCH

Learning Objectives

3.2.1 Contribute to the development of new knowledge by active involvement in research

3.2.2 Demonstrate understanding of the principles of evidence-based medicine, the limitations of evidenceand the challenge of applying research in daily clinical practice

3.2.3 Demonstrate the ability to present research findings in a written or oral form

THEME 3.3: EDUCATOR

Learning Objectives

3.3.1 Recognise the importance of health education and the role of the physician as a teacher to patients,other physicians and in the wider community, and develop the skills to undertake this role


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Domain 4: Cultural Competency

Physicians should display commitment to gaining an understanding of the impact of culture on healthoutcomes. They must endeavour to become acquainted with the cultural perception of illness, cultural aspectsof family, and cultural attitudes toward death and illness held by their patients. Physicians have a responsibility

to manage their own development of cultural competency and familiarise themselves with the differingcultures within the community.

THEME 4.1: CULTURAL COMPETENCY

Learning Objectives

4.1.1 Manage ones own cultural competency development

4.1.2 Demonstrate the ability to communicate effectively with people from culturally and linguisticallydiverse backgrounds

4.1.3 Apply specific knowledge of the patients cultural and religious background, attitudes and beliefs inmanaging and treating the patient

4.1.4 Understand how the special history of Mori and Pacific peoples (NZ) and Aboriginal/Torres StraitIslander peoples (Australia) impacts on their current health status

4.1.5 Identify and act on cultural bias within health care services and other organisations

4.1.6 Demonstrate the ability to promote effective cross-cultural partnerships and culturally diverse teams toimprove health outcomes

Domain 5: Ethics

Physicians must adopt an ethical attitude towards the practice of medicine. Ethics pervades every aspect of

clinical practice, from communication to critical reflection and professional standards. While it is importantto bear in mind the relationship of health law and practice, it is important also to understand the distinctionbetween law and ethics. Physicians must cultivate ethical reflection and ethical behaviour through an awarenessof ethical principles, health law, and the limits of science on behaviour.

THEME 5.1: PROFESSIONAL ETHICS

Learning Objectives

5.1.1 Demonstrate ability to apply an ethical framework in clinical practice

5.1.2 Understand and apply ethical principles underpinning the conduct of research

THEME 5.2: PERSONAL ETHICS

Learning Objectives

5.2.1 Develop a sound professional standard of personal conduct

5.2.2 Demonstrate the ability to critically reflect on personal beliefs, biases and behaviours, and theiralignment with health care policy and impact on interaction with patients

THEME 5.3: ETHICS AND HEALTH LAW

Learning Objectives

5.3.1 Demonstrate the ability to apply legal and ethical frameworks to physicianpatient relationships

5.3.2 Demonstrate the ability to apply relevant legislation and ethical frameworks to interactions outside thedirect physicianpatient relationship


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Domain 6: Clinical Decision Making

Physicians have a unique role, with a distinct body of knowledge, skills, attitudes and behaviours which enablethem to provide clinical care to the highest standards of excellence. Part of this unique role is the physiciansability to apply effective forms of reasoning to make complex clinical decisions.

THEME 6.1: CLINICAL DECISION MAKING

Learning Objectives

6.1.1 Understand and apply the process of diagnostic reasoning

6.1.2 Prognosticate and predict risk

6.1.3 Derive therapeutic decisions which maximise patient benefit and acceptance

6.1.4 Use evidence effectively and efficiently to inform clinical decision making

Domain 7: Leadership and Management

The professional physician must have the ability to manage and make decisions about the allocation ofpersonal, professional and organisational resources.

THEME 7.1: SELF-MANAGEMENT

Learning Objectives

7.1.1 Implement and model effective self-management practices

THEME 7.2: LEADERSHIP AND MANAGING OTHERS

Learning Objectives7.2.1 Demonstrate ability to provide leadership and effectively manage others


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Domain 8: Health Advocacy

Physicians have an obligation, both as individuals and in their profession, to positively influencethe health circumstances of a patient. Opportunities for this may lie outside the immediate clinicalcontext, and the patient may need the physicians support for success. The physician may need to

add their voice where the patient is vulnerable due to infirmity, age or commonly stigmatised status (e.g. race,social class or habit). We refer to this process as advocacy.

Beyond clinical practice, advocacy has a rich history of success in public health where physicians and othershave advocated for, and sustained, favourable change in road safety, immunisation and tobacco control. Thereis also an opportunity for advocacy for changing the environment or focus of care to improve both the qualityand safety of care for others.

In the process physicians will proactively identify, analyse, respond to, promote, and be an advocate for, thesocial, environmental, biological and political factors that determine and impact upon the health and well-being of their patients and the broader community.

THEME 8.1: ADVOCACY FOR THE PATIENT

Learning Objectives

8.1.1 Know and apply the key principles, processes and limitations of advocacy

THEME 8.2: INDIVIDUAL ADVOCACY

Learning Objectives

8.2.1 Identify and address key issues affecting personal work environment and recognise the role of advocacy

THEME 8.3: GROUP ADVOCACY

Learning Objectives

8.3.1 Demonstrate an understanding of the necessary steps required to effect change within the community


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Domain 9: The Broader Context of Health

Physicians have an obligation to think more broadly than the health of the immediate patient. They mustconsider the effects of societal issues on health, and broader health determinants. They must be aware of thekey population and public health principles.

Physicians will encourage and educate patients to achieve healthier lifestyles, and prevent injury, ill health anddisease. To achieve this, familiarity with risk factors (social, environmental, psychological) affecting specificpopulation subgroups, disease-prevention services and legislation are essential.

THEME 9.1: BURDEN OF DISEASE

Learning Objectives

9.1.1 Demonstrate an awareness of health priorities for the local community, and more broadly for Australiaand New Zealand

THEME 9.2: DETERMINANTS OF HEALTH

Learning Objectives

9.2.1 Identify and define the determinants of health

THEME 9.3: PREVENTION AND CONTROL

Learning Objectives

9.3.1 Adopt a population health approach to the prevention of illness, promotion of health and control ofdisease

THEME 9.4: PRIORITY POPULATION GROUPS

Learning Objectives

9.4.1 Implement strategies to reduce inequities in health status between population groups

THEME 9.5: ECONOMICS OF HEALTH

Learning Objectives9.5.1 Demonstrate a basic understanding of the societal, political and economic pressures that influence the

way funding is provided and used


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LEARNING OBJECTIVE TABLES

The following tables indicate the range of underpinning knowledge and skills associatedwith each of the specific learning objectives.

Colour Coding

Colour coding within the tables indicates levels of learning for related knowledge and skills. This is a guide only, andlearning should occur as and when opportunities arise.

White Foundation: These are the underpinning knowledge and skills, many of which draw on initial medicaltraining. These will be taught and learned and most likely assessed during Basic Training.

Tan Higher Order: These build on Foundation knowledge and skills and may be introduced during BasicTraining, although predominantly taught and learned during Advanced Training. These will mostlikely be assessed during Advanced Training.

Orange Extended: This knowledge and these skills will most likely be further developed within the contextof Continuing Professional Development (CPD), but may be introduced during Basic Training or

Advanced Training if the opportunity arises.


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Theme 1.1: PhysicianPatient Communication PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 1.1.1: Apply communication skills to engage and reassure the patient in

specific situations including: first encounters, history taking, counsellingand breaking bad news

Links: PQC 4.1 Cultural Competency; BTC 1.1.1; 1.2.5

KNOWLEDGE SKILLS

Structure of an effective interview.

Questioning and listening techniques.

Demonstrates the ability to build rapport with thepatient.

Demonstrates the ability to communicate effectivelywith adolescents.

Demonstrates active listening by:

y making appropriate eye contact

y asking open-ended questions

y attending to verbal and non-verbal cues

y clarifying information provided by patient

y clarifying patients understanding of informationdelivered.

Gives feedback to patient in an open and honest way.

Uses body language appropriately.

Uses various questioning techniques to elicit informationfrom the patient.

Aspects of culture and language, which may affect thecommunication encounter.

Aspects of condition, illness or medication, which mayhinder communication.

Aspects associated with age, disability, emotional ormental state which may affect the communicationencounter.

Lay terms for medical jargon.

Identify scenarios where information may be withheld.

Know complaint and independent review procedures.

Demonstrates the ability to overcome obstacles tocommunication, using an interpreter or technologywhere necessary, to facilitate effective communication.


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Domain 1: Communication (Cont.)

KNOWLEDGE (Cont.) SKILLS (Cont.)

Knowledge of relevant cultural practices, e.g. importanceof involving extended family for Indigenous people.

Knowledge of relevant translation services and practices.

Demonstrates the ability to describe complex medicalconditions in a way in which the patient can understand;i.e. pitch language use at the level of the patient.

Demonstrates the ability to convey and discussinformation on risks and benefits of tests or treatment:

y express quantitative information clearly andavoid bias

y put information into context

y make information real and relevant

y use multiple formats to increase understanding

y be open and frank about uncertainty

y

be sensitive and check for understanding.Applies quality and safety guidelines to all communicationencounters, including communicating risk, opendisclosure, and obtaining consent.

Manages time pressures, environment, and personalfactors which may affect communication.

Knowledge of the emotional dimensions ofcommunication including counter-transference andemotional involvement.

Develops the ability to support a patient in distress,especially when breaking bad news.

Manages own emotional reaction to information andsituations in order to promote effective communication.

Develops the ability to appropriately close a consultation.

Manages patient follow-up (further consultation and/orwritten communication).

Sources further information for patients.

Maintains accurate, adequate and comprehensiblemedical records.

Manages and reflects on patient complaints.


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Theme 1.1: PhysicianPatient Communication PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 1.1.2: Empower patients and be respectful of their rights in all aspects of

communication

Links: PQC 5.1 Professional Ethics

KNOWLEDGE SKILLS

Right to be involved in decision making to the extentthat the patient feels comfortable.

Knowledge of and access to interpretative services.

Right to confidentiality, even when using an interpreter.

Right to be given accurate, appropriate, unbiasedinformation about the risks and benefits of test and

treatment options.

Identifies patients preferred decision making approachto the situation and responds appropriately.

Identifies level of health literacy in the patient, and helpseducate the patient accordingly.

Identifies and manages communication barriers withpatients who:

y are elderly

y are adolescent

y have a different cultural background

y speak a different language

y have visual or hearing impairments

y have a learning disability

y have poor literacy or numeracy

y have poor health literacy.

Applies the legal and ethical requirements for obtainingconsent from patients.

Determines information that is relevant to the patientand conveys this to them in a way they can understand.

Clearly describes the risks and benefits in the context,and acknowledges any uncertainty.

Respects patients who withdraw consent.

Risks and benefits associated with different courses ofaction and their degree of certainty/uncertainty.

Methods for maximising the effective communication withpatients of reasoning behind clinical recommendations.

Legal and ethical requirements for obtaining consentfrom patients.


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Theme: 1.2: Communicating with a PatientsFamily and/or Carers

PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 1.2.1: Apply communication skills in encounters with a patients family(including extended family) and/or carers

KNOWLEDGE SKILLS

The role of the significant other in managing thechronically ill patient.

Legal and ethical requirements for obtaining consent byfamily or carer on behalf of patient.

Legal and ethical requirements for discussions abouthealth management of the patient with the family orcarers.

The specific issues of confidentiality in this situation.

How to involve family or carer in an effective interview.

Aspects of culture and language that may affect thecommunication encounter; e.g. importance of extended

family.

Lay terms for medical jargon.

Identifies significant others, and determines theirrelationship to the patient and each other.

Identifies the role of significant other people anddetermines the need for these people to be involved.

Obtains consent from the patient to share informationwith significant others or to have them present.

Obtains a collaborative history.

Manages time pressures, environment, and personalfactors that may affect communication.

Develops the ability to build rapport with the patientsfamily or carer.

Manages alternative and conflicting views fromsignificant others.

Develops the ability to support a patients family or carerif they are in distress, especially when breaking bad news.

Manages dissatisfied families or carers.

Identify scenarios where information may be withheld.

Complaint and independent review procedures.

The importance of negotiation to enable seeing young

people alone.

Facilitate communication, where appropriate,between the young person and theirparents/guardians around difficult issues, and decide withthem which issues to discuss with parents/guardians.


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Theme 1.3: Communicating with Colleagues andBroader Health Care Team


Learning Objective 1.3.1: Communicate effectively within multidisciplinary teams

KNOWLEDGE SKILLS

Understanding the impact of legal, policy and ethicalconsiderations in communicating within the team.

Understand the role of the team in health caremanagement, including:

y knowledge of the skill set and contribution ofteam members

y knowledge of the components of effectiveteamwork

y the barriers to effective teamwork.

Demonstrates the ability to communicate clinicalreasoning via case notes, letters, discharge summariesand oral case presentation that facilitate understandingby other clinicians of the writers reasoning and intendedclinical actions.

Manages time pressures, environment and personalfactors that may affect communication.

Identifies and mediates differences between health care

workers, patients and carers.

Uses conflict resolution skills to facilitate team interactions.

Through effective teamwork:

y enhances patient outcomes

y sets achievable patient-management goals.

Gives clear verbal and written communication.

Manages barriers to effective communication withinteams.




Learning Objective 1.3.2: Communicate effectively with referring doctors, and when referring apatient to another specialist

ATTITUDES: Respect patient confidentiality

Respect the role of the referring doctor in patient care

KNOWLEDGE SKILLS

Define the components of an effective referral letter. Explains referral to patient.

Establishes rapport with referring doctors.

Interprets information within a referral letter.

Recognises information that needs enhancement orclarification.

Writes a timely letter containing a clear opinion back tothe referring doctor.

Writes an effective referral letter.


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Learning Objective 1.3.3: Apply communication skills to facilitate effective clinical handover andtransfer of care

Links: BTC 1.2.5 Facilitate Ongoing Care Planning

KNOWLEDGE SKILLS

Describe communication elements required for safe andeffective transfer of care between:

y medical professionals within an institution

y inpatient and outpatient doctors

y primary and secondary care doctors

y different care institutions

y hospital and home

y medical and non-medical caregivers.

Knowledge of communication factors impacting oncontinuity of care.

Demonstrates skills in:

y mouse and keyboard use

y email and the internet and, where applicable,electronic discharge summaries and prescribing

y legible handwriting

y voice dictation and electronic communication

y verbal skills over the telephone and during ahandover meeting

y identification of self, date, time on all writtencommunications.

Demonstrates the ability to prioritise and communicateaccurately medical problems and disease severity whenhanding over the care of a patient to a colleague invarious clinical situations, including:

y end of shift handover

y

outpatient transfersy inter-hospital transfers

y transfers between specialties

y junior doctor to specialist handovers within aservice by telephone.

Demonstrates ability to:

y write a discharge plan identifying relevant tasksto be completed before discharge in a timelymanner

y coordinate medical aspects of care with other

professionals towards attaining these tasks

y keep patients and significant others informed ofprogress towards this plan.


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Learning Objective 1.3.4: Communicate effectively with health administration

Links: PQC 8.1 Advocacy for the Patient

KNOWLEDGE SKILLS

Knowledge of the health-administration system, itsstructures and governance arrangements.

The importance of communication at this level tosupport physicianpatient, multidisciplinary team andother communication.

Communicates effectively with:

y health managers

y policy makers.

Identification of structural barriers to communication. Involves health managers as part of a multidisciplinary

team to obtain resources, data and access to services forbetter patient outcomes.


Theme 1.4: Communicating with the BroaderCommunity


Learning Objective 1.4.1: Communicate effectively with support organisations, administrativebodies, governments and others in the wider community

Links: PQC 8.1 Advocacy for the Patient; PQC 7.2 Leadership and Managing Others

KNOWLEDGE SKILLS

Knowledge of the relevant agencies and the services theyprovide.

Knowledge of the cost of accessing services.

Facilitates communication with such organisations onbehalf of the patient.

Knowledge of effective communication strategies forworking with the media.

Manages communication with media.

Contributes to continuing education of patient supportand community groups.


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Theme 1.4: Communicating with the BroaderCommunity


Learning Objective 1.4.2: Demonstrate the ability to apply specific medico-legalcommunication practices

KNOWLEDGE SKILLS

Relevant health/medical legislation. Demonstrates the ability to source information andprepare specific medico-legal communication including:

y police statement

y letter of support on behalf of the patient

y expert opinion report

y giving evidence in court

y

preparing an opinion for the communityadvocate or guardianship tribunal.

Relevant state/hospital/workplace policies and guidelines.

When witnesses are required, and who can be a witness.

Open disclosure guidelines.

Access rights to confidential medical records.

Procedure for obtaining consent for release of confidentialmedical records and images to a third party.

Demonstrate the ability to give an objective andconsidered opinion.


Theme 2.1: Using Evidence and Information PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 2.1.1: Use evidence to inform quality improvement

KNOWLEDGE SKILLS

Understand quality improvement methodology and thequality improvement cycle.

Describe information and technology tools available forpreventing errors.

Applies quality improvement methodology.

Determines how applicable the evidence is to anindividual patient.

Uses technology to access material to inform qualityimprovement.

Makes evidence available to co-workers and patients.


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Theme 2.2: Safe Practice PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 2.2.1: Optimise safe work practice, which minimises error

Links: PQC 1.3 Communicating with Colleagues and the Broader Health Care Team

KNOWLEDGE SKILLS

Demonstrate knowledge of the components of safeworking environments and cultures.

Understand the work organisation how it works, andthe interrelationships of its rules, regulations and policies,governance and structure.

Understand the importance of clear goals and objectivesfor the health care team.

Ensures team members understand their personal andcollective responsibility for the safety of patients.

Facilitates and maintains effective and efficient teamworkincluding:

y encouraging participation of all team members

y ensuring all team members maintain appropriate

standards of conduct and carey providing effective supervision

y coaching new members

y establishing clear lines of accountability andauthority

y ensuring the team has the right competenciesand the right mix of competencies

y ensure patients know how to contact theteam with questions or concerns about theirtreatment

y encouraging effective communication

y using rewards appropriately

y encouraging innovation.

Monitors team objectives and provides regular individualand team feedback.

Trains staff to identify work conditions that cause errors,and to be vigilant in the workplace.

Understand the characteristics of effective teams, thedifferent types of health care teams, and the barriers to

forming effective teams.

Understand the roles of team members, and the impactof change on the team.

Understand the role of out-of-hours teams in improvingpatient care.

Knowledge of the role the work environment plays inhuman errors.

Knowledge of pre-emptive error-proofing strategies.

Understand the steps involved in the patient verificationprocess to avoid misidentification.

Understand the factors that can reduce misidentification.

Involves staff in designing their work environment andstandardising work practices. [CPD]

Manages fatigue and stress within the team.

Introduces error-proofing strategies into the workplace.

Follows verification procedures to ensure the correctpatient receives the right treatment at the right time.

Involves staff and patients in checking the identity ofpatients using or about to receive a service or treatment.


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Learning Objective 2.2.2: Facilitate safe prescribing and administration of medication and display

an understanding of the associated error types, causes and risks

Links: BTC 1.2. Patient Care and Therapeutics

KNOWLEDGE SKILLS

**Quality Use of Medicine Guidelines National MedicinePolicy, Dept Health and Ageing.**

Understand the relevant actions, indications,contraindications and effects of medications.

Knowledge of where information about adverse effectscan be found.

Knowledge of the principles of drug monitoring.

Identify where and when errors are most likely tooccur and the opportunities for error in the process ofadministering medications for different patient locations.

Define methods to minimise medication errors.

Understand the benefits of a multidisciplinary approachto medication safety.

Knowledge of reporting systems for medication errors.

Understand the legal and regulatory frameworks aroundprescribing as they apply to everyday clinical practice.

Demonstrates the ability to:

y prescribe and administer medications safely

y educate patients about their medications

y accurately calculate all drug doses

y identify relative and absolute contraindications

y report all medication errors (prescribing,dispensing, administering) and near misses

y write clearly and legibly.

Takes steps to reduce the occurrence of medicationerrors.

Analyses and learns from medication errors.

Actively manages patients by reviewing long-term repeatprescribing.

Uses information technology to support prescribing,dispensing and administering of medications.



Learning Objective 2.2.3: Promote safe continuity of care for patients

KNOWLEDGE SKILLS

Understand how patients move between systems of care.

Define the components of a patient-centred service.

Awareness of guidelines and protocol for transfer andhandover of patients.

Understand how shift changes, casual and short-termstaff, rotations, or locums impact on the patientscontinuity of care.

Establishes and maintains effective patient handover anddischarge systems.

Establishes a system to identify the medical staff membersresponsible for the patients care at all times.

Anticipates and addresses potential important issuesduring handover.


Theme 2.3: Identifying, Preventing andManaging Potential Harm


Learning Objective 2.3.1: Recognise, report on and manage adverse events and error


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KNOWLEDGE SKILLS

Define an adverse event and a near miss.

Distinguish between system and individual errors.

Understand how errors are defined, and the models for

understanding health care errors and system failures.

Identify the most common adverse events in theworkplace.

Recognise the many factors that contribute to adverseevents including system, environmental, situational andprofessional factors.

Know reporting processes.

Recognise the learning opportunities from reportingerror.

Be aware of the legal aspects of investigation anddisclosure of adverse events.

Describe the process of analysis of incident reports usedby your workplace.

Gain a basic understanding of the principles underpinningsystems theory, and the role complex systems play inerrors.

Have a basic understanding of quality improvementmethodology.

Recognises and manages personal errors.

Reports appropriately on adverse events.

Analyses incident reports, adverse events and near missesto identify opportunities for improvements in patientcare.

Appropriately manages the patients and staff needswhere they are involved in an adverse event.

Identifies ways in which adverse events may be avoidedin future.

Recognises the psychological precursors of error attitude, inattention, distraction, preoccupation,

forgetfulness, fatigue and stress and implementsstrategies aimed at reducing or managing these errors.

Employs quality improvement methods, and analysisof environmental and human factors, to prevent futureerrors and reduce adverse events.


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Learning Objective 2.3.2: Identify, establish, implement and/or comply with relevantrisk-management/minimisation procedures

KNOWLEDGE SKILLS

Understand the process for risk assessment and reportinghazards and risks in the workplace.

Describe ways in which risk-management can reduceadverse events of injury to patients or staff, andunderstand the value of incident management.

Know who the designated occupational health andsafety officer is.

Know and understand the risks and hazards associatedwith the use of various investigations; e.g. ionisingradiation, radio isotopes, and invasive investigations.

Reports known hazards and risks in the workplace.

Uses information from complaints, incident reports,litigation, Coroners reports and quality improvementreports, and risk assessment to control risks.

Develops the ability to work with the designated officerresponsible for occupational health and safety.

Establishes and implements specific activities thatwill reduce adverse events and risk, such as improvedsupervision, triage and protocols (e.g. hand washing,infection control, confidentiality).

Develops the ability to follow procedures associated withpotentially hazardous investigations.




Learning Objective 2.3.3: Understand the process of managing patient complaints and how toutilise patient complaints to enhance medical care

KNOWLEDGE SKILLS

Understand how complaints can improve services.

Be aware of the complaint management policy foryour organisation and the components of an effectivecomplaint-management system.

Understand the principle of open disclosure.

Develops the ability to respond appropriately tocomplaints and use information to make improvementsto health service delivery.

Actively seeks feedback from patients and carers about

their health provision.Refers complaints raising significant health and safetyissues to the appropriate body.


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Theme 3.1: Ongoing Learning PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 3.1.1: Participate in effective continuing professional and educational

development

KNOWLEDGE SKILLS

Understand different learning styles.

Understand the methods available to assess ones ownlearning needs.

Knowledge of the RACP Continuing ProfessionalDevelopment Program.

Identifies preferred learning style(s).

Identifies resources available for continuing professionaland educational development.

Develops and demonstrates a systematic approach to:

y using a training needs analysis to identify andprioritise learning needs

y developing a plan to manage learning needs

y using reflective learning techniques.

Models and actively promotes continuing professionaland educational development among staff andprofessional colleagues.

Utilises e-portfolios to facilitate learning.

Participates in the RACP professional developmentprogram (final year of advanced training).


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Theme 3.2: Research PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 3.2.1: Contribute to the development of new knowledge by active involvement

in research

KNOWLEDGE SKILLS

Understand qualitative and quantitative researchmethods.

Understand key bio-statistical and epidemiological toolsused in research.

Be familiar with a range of sources of research publicationsand electronic literature databases.

Be familiar with scientific style of writing, e.g.

y research grant

y publication

y referee

y ethics submission.

Understand the process of peer review.

Identify sources of research funding.

Formulates a research question.

Performs a literature search and review.

Critically appraises information from different sources.

Develops appropriate protocol and methods forresearch, including submission to an appropriate ethicscommittee.

Applies knowledge of statistical methods.


y plan and execute a research project

y collect, store, analyse and evaluate research data

y write a scientific or medical paper includingappropriate referencing.

Apply for research funding.



Learning Objective 3.2.2: Demonstrate understanding of the principles of evidence-basedmedicine, the limitations of evidence and the challenge of applyingresearch in daily clinical practice

KNOWLEDGE SKILLS

Understand advantages and disadvantages of differentstudy methodologies (e.g. case controlled cohorts,randomised controlled trials etc).

Understand the factors contributing to validity ofresearch.

Demonstrates the ability to critically appraise researchliterature:

y formulate a clinical question from a case scenarioor clinical case

y conduct a literature search

y evaluate the quality and applicability of evidence

y identify the limitations of evidence.

Applies evidence to a specific clinical situation anddescribes how findings influence practice.

Understand the challenge of translating research intoclinical practice.


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Learning Objective 3.2.3: Demonstrate the ability to present research findings in a written or

oral form

KNOWLEDGE SKILLS

Demonstrate knowledge of the accepted format forscientific papers.

Understand the process for preparing research forpublication.

Be aware of referencing protocol.

Demonstrates the ability to present research data inwritten form, including:

y writing an abstract

y preparing research for publication

y writing an ethics application

y using appropriate referencing and referencingsoftware.

Demonstrates the ability to present research data in oralform, including:

y presentation at College Congress or equivalent

y presentation at Grand Rounds

y poster presentation.


Theme 3.3: Educator PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 3.3.1: Recognise the importance of health education and the role of thephysician as a teacher to patients, other physicians and in the widercommunity, and develop the skills to undertake this role

KNOWLEDGE SKILLS

Demonstrate knowledge of different learning styles. Facilitates learning of patients especially with regard toself-management, community services and liaison.

Understand the most effective methods of delivery ofhealth education.

Facilitates learning of colleagues and students.

Recognises and maximises learning opportunities.

Applies knowledge of different learning styles toteaching/learning activities.

Plans and implements teaching/learning activities withcolleagues and other people in the health care team.

Uses available information and develops new informationto inform patients, and deliver health education.


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Theme 4.1: Cultural Competency PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 4.1.1: Manage ones own cultural competency development

Links: PQC Domain 1: Communication

KNOWLEDGE SKILLS

Understand key concepts, terms and stages in culturalcompetence.

Understand the importance of being culturally sensitiveto enhance patient care.

Understand the effects of cultural insensitivity.

Identifies own cultural learning needs and undertakesself-directed learning.

Identifies own cultural biases and the influence they haveon interaction with others.



Learning Objective 4.1.2: Demonstrate the ability to communicate effectively with people fromculturally and linguistically diverse backgrounds

KNOWLEDGE SKILLS

Understand the potential barriers to effective cross-cultural communication.

Know about the resources available to support cross-cultural practice (interpreters, translated resources,community partners).

Understand the legal and ethical issues around usingchildren and relatives as interpreters.

Communicates effectively with people from culturallyand linguistically diverse backgrounds.

Demonstrates the ability to source and use interpretersand translators.

Uses appropriate non-verbal communication.


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Learning Objective 4.1.3: Apply specific knowledge of the patients cultural and religious

background, attitudes and beliefs in managing and treating the patient

KNOWLEDGE SKILLS

Be aware of different belief systems and their impact onpatients and their care.

Understand health inequalities among culturally andlinguistically diverse communities.

Know cultural demographics of the community in whichhe/she practices.

Accesses and uses information about culturally andlinguistically diverse communities, their histories andspecific health issues as the context for understandingculture and health interactions.

Uses information relating to:

y family

y diet

y beliefs

y health practices

y client expectations

y customs, and

y migration history

in the management, treatment and care of the patient.



Learning Objective 4.1.4: Understand how the special history of Mori and Pacific peoples (NZ) andAboriginal/Torres Strait Islander peoples (Australia) impacts on theircurrent health status

KNOWLEDGE SKILLS

Understand how loss of land, language and culture hasimpacted on socio-economic status and independence.

Understand how government and non-governmentpolicies and media portrayal has impacted on self-

efficacy (mastery).Understand the historical negative perceptions ofhospitals in relation to death and cultural respect.

Understand the facets of indigenous culture that createstrong ties within families and communities, and howthis can impact on interactions between indigenouspeople and health services.

Accesses and uses information about indigenouspopulations and their histories as the context forunderstanding culture and health interactions.

Identifies judgemental approaches and develops

empathic strategies to gain trust.Accesses and uses information about indigenouspopulations and their specific health issues as the context

for understanding culture and health interactions.

Accesses and uses information about indigenouspopulations and their culture as the context forunderstanding health interactions.


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Learning Objective 4.1.5: Identify and act on cultural bias within health care services and other

organisations

Links: PQC 8.1 Advocacy for the Patient; POC 8.3 Group Advocacy

KNOWLEDGE SKILLS

Understand organisational cultural insensitivity and itsimpact on patient care.

Identifies and takes appropriate action to address culturalbias in colleagues and within the health care organisation.

Advises colleagues on non-discriminatory work practicesand advocates for change when such practices aredisplayed.



Learning Objective 4.1.6: Demonstrate the ability to promote effective cross-cultural partnershipsand culturally diverse teams, to achieve improved health outcomes

Links: PQC 1.3 Communicating with Colleagues and Broader Health Care Team

KNOWLEDGE SKILLS

Understand how policy and practices of dominantcultures influence the health of other groups.

Identifies the values and needs of non-dominant culturalgroups.

Understand culture as a determinant of health. Develops partnerships with appropriate individuals,organisations and representative networks, and seeksinformation and advice when working with other culturalgroups.

Understand the impact of culture on the behaviour ofcolleagues and staff.

Understand the value of using culturally aligned healthworkers.

Promotes intra-cultural and cross-cultural relationships.


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Domain 5: Ethics

Theme 5.1: Professional Ethics PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 5.1.1: Demonstrate the ability to apply an ethical framework in clinical

practice

KNOWLEDGE SKILLS

Understand bioethical principles:

y justice

y autonomy

y beneficence

y non-maleficence.

Understand the place of:

y religion

y moral beliefs

y values

y social justice

y cultural practices

in contributing to ethical decision making.

Demonstrate knowledge of international, national, state/territory and local codes, principles and declarationsregarding ethical conduct.

Develops the ability to apply a range of problem-solvingtechniques to ethical dilemmas.

Applies ethical principles in a variety of situations,including but not limited to:

y physicianpatient relationship

y inter- and intra-professional relationships

y competence and consent

y dealing with older patients

y end-of-life care

y withdrawal of care

y genetics

y relationship with industry

y research

y resource allocation.

Domain 5: Ethics

Theme 5.1: Professional Ethics PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 5.1.2: Understand and apply ethical principles underpinning the conductof research

Links: PQC 3.2 Research

KNOWLEDGE SKILLS

Demonstrate knowledge of international, national, state/territory and local codes, principles and declarationsregarding the ethical conduct of research.

Be aware of legal regulation around research at federal,state and territory levels.

Demonstrate knowledge of the principles of informedconsent.

Clearly identifies the purpose of the research.

Obtains approval for research (and modification ofresearch) from the appropriate ethics committee prior tocommencing research.

Conducts scientifically valid research with methods thatare appropriate to aims.

Obtains genuine informed consent from the subject orappropriate legally authorised guardian.

Carefully considers, manages and minimises riskassociated with research. (Beneficence and non-maleficence.)


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Domain 5: Ethics

Theme 5.2: Personal Ethics PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 5.2.1: Develop a sound professional standard of personal conduct

Links: PQC Domain 2: Quality and Safety; PQC Domain 4: Cultural Competency; PQC 5.1Professional Ethics; PQC: 5.2 Personal Ethics

KNOWLEDGE SKILLS

Demonstrate knowledge of:

y duty of care

y patients rights

y relevant codes of conduct

y legal responsibilities under the relevant Health

Acts.Quality use of Medicines guidelines.

Risk-management/minimisation procedures.

Adheres to codes of conduct of registration boards inlocal jurisdictions.

Recognises professional limitations and is prepared torefer as appropriate.

Manages differences in opinion.

Manages adverse events and errors appropriately.

Medicates safely.

Responds professionally and appropriately to complaints.

Domain 5: Ethics

Theme 5.2: Personal Ethics PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 5.2.2: Demonstrate the ability to critically reflect on personal beliefs, biases

and behaviours, their alignment with health care policy and impact oninteraction with patients

KNOWLEDGE SKILLS

Demonstrate awareness of different belief and valuesystems.

Understand the relationship of a belief system and howthis may contribute to decisions about treatment.

Establishes a means for critically reflecting on ownattitudes and values.

Develops the ability to recognise personal moralconsiderations within the context of ethical decisionmaking.

Critically reflects and analyses own and policy viewpointson ethical dilemmas such as:

y euthanasiay life-sustaining treatment

y not for resuscitation orders

y abortion

y contraception.

Informs the patient and seeks alternative care for apatient where a personal moral judgement or religiousbelief prevents appropriate professional engagement.

Develops appropriate actions to manage situationswhere ones own beliefs and institutional policy are notaligned.


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Domain 5: Ethics

Theme 5.3: Ethics and Health Law PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 5.3.1: Demonstrate the ability to apply legal and ethical frameworks to

physicianpatient relationships

KNOWLEDGE SKILLS

Understand the legal framework around privacy andconfidentiality as it relates to the physicianpatientrelationship.

Understand the legal aspects of informed consent andthe importance of obtaining consent.

Understand the patients right to make their owndecisions, and their rights regarding refusal of treatment/procedures.

Understand the legal position regarding consentto partake or withdraw from medical treatment foradolescents.

Understand the legal principles around decision makingcapacity (competence) including the appointment ofsurrogate decision makers.

Understand the legal issues around involuntary admissionand involuntary detention.

Understand the legal concept of restraint.

Understand the considerations that need to be madebefore a patient is restrained.

Understand use of physical and pharmacologicalrestraints.

Be aware of Occupational Health and Safety legislation/guidelines, especially when treating mentally ill patients.

Develops the ability to maintain privacy andconfidentiality in all patient encounters.

Applies appropriate and effective communicationtechniques to obtain consent.

Discusses all treatment options, regardless of healthinsurance or financial status of patient.

Seeks consent for conduct of medical procedures andtreatments.

Develops the ability to identify the need for a formalassessment of decision making capacity and refersappropriately.

Provides full information about the risks and benefits ofa procedure or treatment, and possible risks/side-effects.

Develops the ability to make an application forinvoluntary retention of a patient.

Consults with the health care team, and relatives (orperson responsible for the patient), where possible,before restraining the patient.

Records any restraint required and the reason for the

restraint.


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Domain 5: Ethics

Theme 5.3: Ethics and Health Law PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 5.3.2: Demonstrate the ability to apply relevant legislation and ethical

frameworks to interactions outside the direct physicianpatientrelationship

KNOWLEDGE SKILLS

Demonstrate knowledge of when reporting is necessaryand appropriate and when it is mandated by legislation.

Demonstrate knowledge of legal issues particularly thoserelating to:

y death certification

y role of the Coroner (local Coroners Act)

y mental illness

y advance directives/living wills

y surrogate decision making

y organ donation and retention

y driving and medical risk

y child protection

y communicable diseases.

Demonstrates the ability to report to the appropriateauthority.

Applies knowledge of legal issues to clinical practice.


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Theme 6.1: Clinical Decision Making PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 6.1.1: Understand and apply the process of diagnostic reasoning

KNOWLEDGE SKILLS

Processes of diagnostic reasoning

Explain the probabilistic nature of clinical medicine.

Define the steps of hypothetico-deductive diagnosticreasoning:

y perceiving and interpreting symptoms and signs

y formulating initial conceptualisation of theclinical problem(s)

y generating hypotheses

y testing, refining and verifying hypotheses usingfocussed inquiry strategies

y developing problem synthesis(es) and problemlists.

Demonstrates an understanding of clinical disease andevent probabilities.


y perceive and interpret clinical features, to gaugetheir reliability and import, and to distinguishnormal from abnormal cues

y construct an inclusive, concise and meaningfulproblem statement based on initial data

y generate plausible hypotheses at an early stage

y interpret and integrate data, collect additionalrelevant data using hypothesis-directed inquirystrategies, and reformulate and refine workinghypotheses

y construct a meaningful and concise problemsynthesis and problem list.



Learning Objective 6.1.2: Prognosticate and predict risk

KNOWLEDGE SKILLS

Explain the concepts of natural history of disease, absoluterisk, attributable risk, multivariate risk prediction, riskcalculators, and cohort studies.

Understand the potential biases affecting the validity ofcohort studies, case-control studies, and multivariate riskmodels in defining future risk of events and prognostic

factors.

Applies risk prediction rules and risk calculators todefining event risk in individual patients.

Demonstrates the ability to appraise studies that definerisk to individual patients.


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Learning Objective 6.1.3: Derive therapeutic decisions which maximise patient benefit and

acceptance

KNOWLEDGE SKILLS

Explain the concepts of relative risk reduction (RRR),absolute risk reduction (ARR), odds ratio (OR), numberneeded to treat (NNT), number needed to harm (NNH).

Understand the potential biases affecting the validity ofclinical trials.

Explain how the average benefits and risks oftreatments as measured and reported in clinical studiesare individualised in caring for specific patients.

Describe methods by which patients can betterunderstand the evidence behind different managementoptions and assist them in choosing one option overanother.

Demonstrates the ability to use measures of ARR andNNT/H in relation to key therapies for common clinicalconditions.

Demonstrates the ability to appraise the validity oftherapeutic trials.

Demonstrates an understanding of, and ability to apply,where appropriate, decision aids for patients.



Learning Objective 6.1.4: Use evidence effectively and efficiently to inform clinical decisionmaking

KNOWLEDGE SKILLS

Describe the methods for retrieving relevant and validinformation from the medical literature that can be usedin optimising clinical decisions.

Describe the potential applications of systematic reviews,clinical prediction rules, decision analysis, and clinicalpractice guidelines.

Understand commonly used statistical methods.

Demonstrates the ability to retrieve high-qualityinformation from electronic sources.

Demonstrates the ability to retrieve, comprehend andapply results of systematic reviews, clinical predictionrules, decision analysis, and clinical practice guidelines.

Demonstrates an understanding of confidence intervals,levels of significance (p values), and study power wheninterpreting results of clinical trials.

Demonstrates ability to identify error in reasoning andreflect on ones own clinical reasoning process.


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Theme 7.1: Self-management PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 7.1.1: Implement and model effective self-management practices

Links: PQC 1.3.1 Communicating with Colleagues and Broader Health Care Team; PQC 4.1Cultural Competency

KNOWLEDGE SKILLS

Understand effective time and stress-managementtechniques.

Incorporates health maintenance as part of professionallife including regular contact with ones own GP.

Demonstrates time-management and prioritisation skills.

Demonstrates effective delegation and follow-up skills.

Works effectively in multidisciplinary and cross-culturalteams.

Identifies stressors and takes action to minimise theireffects.

Effectively manages stressful situations that may arise,and knows when to ask for help.

Effectively manages personal and professionaldevelopment.

Cultivates the ability to identify ones own mistakes andlearn from them.

Manages relationships effectively, including those with:

y patients and their families

y colleagues

y the broader health care team.

Effectively manages the balance between work life andhome life.

Recognises and responds to personal and professionallimitations.


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Theme 7.2: Leadership and Managing Others PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 7.2.1: Demonstrate ability to provide leadership and effectively manage

others

Links: PQC 1.3 Communicating with Colleagues and Broader Healthcare Teams; PQC 3.3Educator

KNOWLEDGE SKILLS

Principles and practices of effective leadership and teammanagement.

Understand the structure of the workplace, and the staffresources available.

Understand the importance and process/procedures for

staff appraisal.Understand the importance of constructive andconsistent feedback to staff.

Demonstrates effective leadership skills.

Demonstrates the ability to effectively manage staff andhospital resources including:

y showing leadership

y communicating effectively

y prioritising tasks

y assigning tasks and delegating

y prioritising and re-prioritising clinical tasks in theon-take day and during medical disasters

y ensuring tasks are progressing as planned

y coaching and mentoring as appropriate.

Demonstrates the ability to conduct a staff appraisal.

Demonstrates the ability to give appropriate and helpfulfeedback to staff.


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Theme 8.1: Advocacy for the Patient PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 8.1.1: Know and apply the key principles, processes and limitations of

advocacy

Links: PQC Domain 1: Communication; PQC Domain 4: Cultural Competency; PQC 9.3Prevention and Control

KNOWLEDGE SKILLS

Understand the key principles and processes of advocacy.

Recognise the limitations of advocacy.

Understand the role of the community advocate/publicguardian.

Understand that advocacy can be costly at a personal

level.

Know available community/family services.

Understand effective communication strategies foradvocacy.

Know when legal action/appeals process on behalf of thepatient is required.

Identifies key issues for the patient, and where they needan advocate; e.g.

y health insurance

y housing

y immigration/refugee status

y job search and training

y substance abuse/smoking cessation

y teen/youth resources

y asthma support

y child abuse and trauma services

y child care support

y disability services

y respite care

y elder abuse

y nursing homes

y education

y food and nutrition

y domestic violence/sexual assault, and

y gay and lesbian resources.

Communicates effectively with community and familyservices.

Identifies potential barriers to change, and developsappropriate strategies to overcome these.

Elevates advocacy efforts as and when necessary.


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Theme 8.2: Individual Advocacy PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 8.2.1: Identify and address key issues affecting personal work environment and

recognise the role of advocacy

Links: PQC 5.2 Personal Ethics; PQC 2.2. Safe Practice; PQC 2.3 Identifying, Preventing andManaging Potential Harm

KNOWLEDGE SKILLS

Understand the work environment, including policies,practices and governance.

Understand factors which may adversely affect the workenvironment, e.g. undue stress, systems, procedures,processes, access to training etc.

Understand the key principles and processes of advocacy.Recognise the limitations of advocacy.

Prepares effective written or verbal arguments forchange.

Develops the ability to build support from colleaguesand/or community to promote change.

Takes action to bring about effective change.

Develops the ability to take on a leadership role.


Theme 8.3: Group Advocacy PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 8.3.1: Demonstrate an understanding of the necessary steps required to effectchange within the community

Links: PQC 9.4 Priority Population Groups; PQC 5.1 Professional Ethics; PQC 5.3 Ethics andHealth Law

KNOWLEDGE SKILLS

Be aware of population groups with particular healthneeds, e.g. refugees, aged, rural/remote communitiesetc.

Identify relevant public health issues.

Understand the relevant political, governmental, andinstitutional systems relating to health care.

Know the relevant key policies, practices and laws, which

affect specific groups of people.


y advocate for a change in legal requirements

y work with the media

y undertake political lobbying

y gain the necessary support to effect change

y identify barriers and ways to overcome them

y work in a team

y advocate for appropriate health resourceallocation.


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Domain 9: The Broader Context of Health

Theme 9.1: Burden of Disease PROFESSIONAL QUALITIES CURRICULUM

Learning Objective 9.1.1: Demonstrate an awareness of the health priorities for the local

community, and more broadly for Australia and New Zealand

KNOWLEDGE SKILLS

Have an understanding of the key public health problems,and health needs of priority population groups, e.g.Mori and Pacific Islander health, Aboriginal and TorresStrait Islander health.

Be aware of the major burden of disease in Australia andNew Zealand.

Understand the importance of capturing informationconsistently over time.

Understand the indicators for measuring health status,such as:

y mortality (e.g. infant mortality, life expectancy,cancer deaths etc)

y hospitalisation rates

y injury rates

y causes of decreased quality of life(e.g. through chronic disease or disability)

y measures of positive dimensions of health

y aggregate health indicators.

Be aware of the National Health Priority Areas (and riskfactors) in Australia (NHPAs):

y asthma

y cardiovascular disease

y cancer

y diabetes

y injury

y mental health

y arthritis and other musculoskeletal conditions

y obesity.

Be aware of the National Health Priority Areas (and riskfactors) in New Zealand (NHPAs):

y smoking

y nutritiony obesity

y physical activity

y alcohol and illicit and other drug use

y suicide

y cancer

y cardiovscular disease

y diabetes

y oral health

y violence

y m

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